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PORTLAND, Ore. - Right now, Portland is the largest non-fluoridated metro area in the country and voters will be deciding whether to allow the city to start adding fluoride to their water.

Ballots go out on May 3 and the issue has families lining up on both sides.

Leah Johnson is the mother of two sons, Gabe, age 10, and Quinn, age 11. She said both boys regularly brush and floss. Yet they have had cavities, crowns, and even a failed root canal.

“It was very difficult for (Quinn) to go through that and me as a mother to watch him go through that,” said Johnson. “It was extremely traumatic.”

Johnson is convinced that fluoride in Portland's drinking water would save her kids' teeth.

“I have 12 cavities, so apparently it wasn't very good for me,” said Kim Kaminski, a mother of two and chair of the anti-fluoride group Clean Water Portland. Kaminski grew up in a fluoridated area of the country.

“We are already way overexposed,” said Kaminski. “Our kids don't need more chemicals.”

Fluoride does occur naturally in water. At the Bull Run Watershed, it measures .1 parts per million (PPM). But the U.S. Department of Health and Human Services identifies the optimal level in public water systems at .7 PPM.

That's the proposal in Portland - to add barrels of fluorosilicic acid to the drinking water. It’s not the same as the pharmaceutical grade fluoride in your toothpaste, but the American Dental Association contends fluoridated drinking water can reduce tooth decay by an additional 20 to 40%.

Some dentists, though, disagree.

“You might want to put it on your teeth to prevent tooth decay, but you really don't want to ingest it because of the toxic consequences of ingesting fluoride,” said Dr. Jay Levy, a Portland dentist who’s been practicing for 30 years.

In his practice, Levy has seen over-fluoridation cause fluorosis, a white staining and pitting of the teeth. He said in severe cases, the damage is permanent.

“Sometimes (when) I take a dental scaler to that area, the tooth literally crumbles away under the force of a routine cleaning,” Levy explained.

But more troubling, Levy points to research, like a Harvard study that links fluoridated water to a rare bone cancer in young boys and another Harvard study that points to lowers IQ scores in kids in China, Mongolia and Iran and a 2006 National Academy of Sciences report on bone fractures.

Most of these studies look at fluoride levels well above the .7 PPM being proposed in Portland. But Levy cautions about accumulation of fluoride in the body from multiple sources, including drinking water, toothpaste, and food.

Dr. Philip Wu is a Portland pediatrician who works in the Kaiser Permanente Community Health department. He, too, has studied fluoridation and takes a different stance.

“You don't exceed anything that comes close to a reasonable and appropriate level of fluoride consumption even given the presence of fluoride in other sources,” said Wu.

Wu does warn that babies younger than six months should not drink baby formula with fluoridated water because it's too much fluoride for their body size.

Some research estimates fluoridated formula could have 250 times more fluoride than mother's milk.

But for everyone else, Wu strongly recommends fluoridation.

“Having fluoride in your drinking water adds an increment of about 25 to 30% of additional gain,” said Wu.

As for our Portland moms, neither is wavering.

“When there is something as simple as fluoride in the water, it just doesn't make sense to me why we wouldn't do that,” said Johnson.

“I think there are questions about safety,” said Kaminski. "And I think there are questions about effectiveness, and when there are questions, we need to err on the side of caution.”

If Portland voters approve fluoridation, they'll pay about 61 cents per person per year. They'll also pay a one-time setup fee of about $5 per resident.